Obstetric and gynecological management in a patient with abnormal invasion of the placenta (placenta percreta)
Anatoliy I. Ishchenko , Oksana Y. Gorbenko , Irina D. Khokhlova , Vladimir M. Zuev , Tea A. Dzhibladze , Dmitrii V. Baburin
V.F.Snegirev Archives of Obstetrics and Gynecology ›› 2024, Vol. 11 ›› Issue (3) : 350 -359.
Obstetric and gynecological management in a patient with abnormal invasion of the placenta (placenta percreta)
Pathological placental invasion is a dangerous anomaly during pregnancy, which causes increased maternal morbidity and mortality. Patients with abnormal placental invasion may experience life-threatening uterine bleeding during delivery, particularly in cases of placenta percreta. This often requires surgical intervention, specifically a hysterectomy, which some researchers refer to as the “gold standard” treatment for pathological placental invasion, with rates ranging from 47% to 77.8%. Conversely, other researchers recommend a conservative approach, involving the complete removal of the placenta percreta, excision of damaged areas on the uterine walls and bladder, and metroplasty and restoration of the integrity of the.
This article presents a clinical case of a 40-year-old patient with a complicated obstetric history, including abnormal placental invasion (placenta percreta) involving the anterior wall of the uterus and the bladder.
Delayed diagnosis of such pathology leads to inappropriate treatment and, consequently, acute massive bleeding, posing a risk to the patient’s health and life. The applied comprehensive diagnostic and therapeutic measures facilitated the preservation of the pelvic organs and restoration of the patient’s reproductive function.
placenta percreta / diagnostics / treatment / rehabilitation
| [1] |
Ignatko IV, Davydov AI, Lebedev VA, et al. Placenta accreta spectrum: risk factors, terminology, classification, management strategies. Gynecology, Obstetrics and Perinatology. 2023;22(4):92–101. EDN: RFSBLS doi: 10.20953/1726-1678-2023-4-92-101 |
| [2] |
Игнатко И.В., Давыдов А.И., Лебедев В.А., и др. Врастание плаценты: факторы риска, терминология, классификация, стратегия лечения // Вопросы гинекологии, акушерства и перинатологии. 2023. Т. 22, № 4. С. 92–101. EDN: LSXSHT doi: 10.20953/1726-1678-2023-4-92-101 |
| [3] |
Ignatko IV, Davydov AI, Lebedev VA, et al. Placenta accreta spectrum: risk factors, terminology, classification, management strategies. Gynecology, Obstetrics and Perinatology. 2023;22(4):92–101. EDN: RFSBLS doi: 10.20953/1726-1678-2023-4-92-101 |
| [4] |
Syundyukova EG, Chulanova YuS, Sashenkov SL, et al. Placenta previa and placenta accreta: questions of diagnosing and obstetric management. Russian Bulletin of Obstetrician-Gynecologist. 2022;22(3):12–20. EDN: STIDHQ doi: 10.17116/rosakush20222203112 |
| [5] |
Сюндюкова Е.Г., Чуланова Ю.С., Сашенков С.Л., и др. Предлежание и врастание плаценты: вопросы диагностики и акушерской тактики // Российский вестник акушера-гинеколога. 2022. Т. 22, № 3. С. 12–20. EDN: STIDHQ doi: 10.17116/rosakush20222203112 |
| [6] |
Syundyukova EG, Chulanova YuS, Sashenkov SL, et al. Placenta previa and placenta accreta: questions of diagnosing and obstetric management. Russian Bulletin of Obstetrician-Gynecologist. 2022;22(3):12–20. EDN: STIDHQ doi: 10.17116/rosakush20222203112 |
| [7] |
Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, et al.; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2019;146(1):20–24. doi: 10.1002/ijgo.12761 |
| [8] |
Jauniaux E., Ayres-de-Campos D., Langhoff-Roos J., et al.; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders // Int J Gynaecol Obstet. 2019. Vol. 146, N 1. P. 20–24. doi: 10.1002/ijgo.12761 |
| [9] |
Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, et al.; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2019;146(1):20–24. doi: 10.1002/ijgo.12761 |
| [10] |
Jauniaux E, Jurkovic D, Hussein AM, Burton GJ. New insights into the etiopathology of placenta accreta spectrum. Am J Obstet Gynecol. 2022;227(3):384–391. doi: 10.1016/j.ajog.2022.02.038 |
| [11] |
Jauniaux E., Jurkovic D., Hussein A.M., Burton G.J. New insights into the etiopathology of placenta accreta spectrum // Am J Obstet Gynecol. 2022. Vol. 227, N 3. P. 384–391. doi: 10.1016/j.ajog.2022.02.038 |
| [12] |
Jauniaux E, Jurkovic D, Hussein AM, Burton GJ. New insights into the etiopathology of placenta accreta spectrum. Am J Obstet Gynecol. 2022;227(3):384–391. doi: 10.1016/j.ajog.2022.02.038 |
| [13] |
Baranovskaya EI. Etiology and diagnosis of placenta accreta. Russian Bulletin of Obstetrician-Gynecologist. 2020;20(3):24–28. EDN: CGFIOB doi: 10.17116/rosakush20202003124 |
| [14] |
Барановская Е.И. Этиология и диагностика placenta accreta // Российский вестник акушера-гинеколога. 2020. Т. 20, № 3. С. 24–28. EDN: CGFIOB doi: 10.17116/rosakush20202003124 |
| [15] |
Baranovskaya EI. Etiology and diagnosis of placenta accreta. Russian Bulletin of Obstetrician-Gynecologist. 2020;20(3):24–28. EDN: CGFIOB doi: 10.17116/rosakush20202003124 |
| [16] |
Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192(5):1458–1461. doi: 10.1016/j.ajog.2004.12.074 |
| [17] |
Wu S., Kocherginsky M., Hibbard J.U. Abnormal placentation: twenty-year analysis // Am J Obstet Gynecol. 2005. Vol. 192, N 5. P. 1458–1461. doi: 10.1016/j.ajog.2004.12.074 |
| [18] |
Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192(5):1458–1461. doi: 10.1016/j.ajog.2004.12.074 |
| [19] |
Pan XY, Wang YP, Zheng Z, et al. A marked increase in obstetric hysterectomy for placenta accreta. Chin Med J (Engl). 2015;128(16):2189–2193. doi: 10.4103/0366-6999.162508 |
| [20] |
Pan X.Y., Wang Y.P., Zheng Z., et al. A marked increase in obstetric hysterectomy for placenta accreta // Chin. Med. J. 2015. Vol. 128, N 16. P. 2189–2193. doi: 10.4103/0366-6999.162508 |
| [21] |
Pan XY, Wang YP, Zheng Z, et al. A marked increase in obstetric hysterectomy for placenta accreta. Chin Med J (Engl). 2015;128(16):2189–2193. doi: 10.4103/0366-6999.162508 |
| [22] |
Matsuo K, Sangara RN, Matsuzaki S, et al. Placenta previa percreta with surrounding organ involvement: a proposal for management. Int J Gynecol Cancer. 2023;33(10):1633–1644. doi: 10.1136/ijgc-2023-004615 |
| [23] |
Matsuo K., Sangara R.N., Matsuzaki S., et al. Placenta previa percreta with surrounding organ involvement: a proposal for management // Int J Gynecol Cancer. 2023. Vol. 33, N 10. P. 1633–1644. doi: 10.1136/ijgc-2023-004615 |
| [24] |
Matsuo K, Sangara RN, Matsuzaki S, et al. Placenta previa percreta with surrounding organ involvement: a proposal for management. Int J Gynecol Cancer. 2023;33(10):1633–1644. doi: 10.1136/ijgc-2023-004615 |
| [25] |
Fonseca A, Ayres de Campos D. Maternal morbidity and mortality due to placenta accreta spectrum disorders. Best Pract Res Clin Obstet Gynaecol. 2021;72:84–91. doi: 10.1016/j.bpobgyn.2020.07.011 |
| [26] |
Fonseca A., Ayres de Campos D. Maternal morbidity and mortality due to placenta accreta spectrum disorders // Best Pract Res Clin Obstet Gynaecol. 2021. Vol. 72. P. 84–91. doi: 10.1016/j.bpobgyn.2020.07.011 |
| [27] |
Fonseca A, Ayres de Campos D. Maternal morbidity and mortality due to placenta accreta spectrum disorders. Best Pract Res Clin Obstet Gynaecol. 2021;72:84–91. doi: 10.1016/j.bpobgyn.2020.07.011 |
| [28] |
Morlando M, Collins S. Placenta accreta spectrum disorders: challenges, risks, and management strategies. Int J Womens Health. 2020;12:1033–1045. doi: 10.2147/IJWH.S224191 |
| [29] |
Morlando M., Collins S. Placenta accreta spectrum disorders: challenges, risks, and management strategies // Int J Womens Health. 2020. Vol. 12. P. 1033–1045. doi: 10.2147/IJWH.S224191 |
| [30] |
Morlando M, Collins S. Placenta accreta spectrum disorders: challenges, risks, and management strategies. Int J Womens Health. 2020;12:1033–1045. doi: 10.2147/IJWH.S224191 |
| [31] |
Shmakov RG, Pirogova MM, Vasilchenko ON, et al. Conservative surgery in abnormal placenta invasion (5-year experience of V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine). Doctor.Ru. 2019;(11):29–34. EDN: UTPKCS doi: 10.31550/1727-2378-2019-166-11-29-34 |
| [32] |
Шмаков Р.Г., Пирогова М.М., Васильченко О.Н., и др. Органосохраняющие операции при аномальной инвазии плаценты (5-летний опыт Национального медицинского исследовательского центра акушерства, гинекологии и перинатологии имени академика В.И. Кулакова) // Доктор.Ру. 2019. № 11. С. 29–34. EDN: UTPKCS doi: 10.31550/1727-2378-2019-166-11-29-34 |
| [33] |
Shmakov RG, Pirogova MM, Vasilchenko ON, et al. Conservative surgery in abnormal placenta invasion (5-year experience of V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine). Doctor.Ru. 2019;(11):29–34. EDN: UTPKCS doi: 10.31550/1727-2378-2019-166-11-29-34 |
| [34] |
Davydov AI, Belotserkovtseva LD, Kilicheva II, Voloshchuk IN. Placenta accreta as a cause of postpartum haemorrhage: questions and answers. Gynecology, Obstetrics and Perinatology. 2014;13(3):52–62. EDN SLBTZZ |
| [35] |
Давыдов А.И., Белоцерковцева Л.Д., Киличева И.И., Волощук И.Н. Врастание плаценты как причина послеродового кровотечения: вопросы и ответы // Вопросы гинекологии, акушерства и перинатологии. 2014. Т. 13, № 3. С. 52–62. EDN SLBTZZ |
| [36] |
Davydov AI, Belotserkovtseva LD, Kilicheva II, Voloshchuk IN. Placenta accreta as a cause of postpartum haemorrhage: questions and answers. Gynecology, Obstetrics and Perinatology. 2014;13(3):52–62. EDN SLBTZZ |
| [37] |
Vinitsky AA, Shmakov RG, Chuprynin VD. Comparative assessment of the effectiveness of surgical hemostasis methods during organ-preserving delivery in patients with placenta accreta. Obstetrics and Gynecology. 2017;(7):68–74. EDN: ZCQQEV doi: 10.18565/aig.2017.7.68-74 |
| [38] |
Виницкий А.А. Шмаков Р.Г., Чупрынин В.Д. Сравнительная оценка эффективности методов хирургического гемостаза при органосохраняющем родоразрешении у пациенток с врастанием плаценты // Акушерство и гинекология. 2017. № 7. С. 68–74. EDN: ZCQQEV doi: 10.18565/aig.2017.7.68-74 |
| [39] |
Vinitsky AA, Shmakov RG, Chuprynin VD. Comparative assessment of the effectiveness of surgical hemostasis methods during organ-preserving delivery in patients with placenta accreta. Obstetrics and Gynecology. 2017;(7):68–74. EDN: ZCQQEV doi: 10.18565/aig.2017.7.68-74 |
| [40] |
Tskhai VB, Pavlov AV, Garber YuG, et al. Evaluation of the effectiveness of uterine artery embolization in reducing intraoperative blood loss in pregnant women with complete placenta previa. Obstetrics and Gynecology. 2015;(8):59–64. EDN: ULQXVN |
| [41] |
Цхай В.Б., Павлов А.В., Гарбер Ю.Г., и др. Оценка эффективности эмболизации маточных артерий в снижении интраоперационной кровопотери у беременных с полным предлежанием плаценты // Акушерство и гинекология. 2015. № 8. С. 59–64. EDN: ULQXVN |
| [42] |
Tskhai VB, Pavlov AV, Garber YuG, et al. Evaluation of the effectiveness of uterine artery embolization in reducing intraoperative blood loss in pregnant women with complete placenta previa. Obstetrics and Gynecology. 2015;(8):59–64. EDN: ULQXVN |
| [43] |
Koyama E, Naruse K, Shigetomi H, et al. Combination of B-Lynch brace suture and uterine artery embolization for atonic bleeding after cesarean section in a patient with placenta previa accreta. J. Obstet. Gynaecol. Res. 2012;38(1):345–348. doi: 10.1111/j.1447-0756.2011.01699.x |
| [44] |
Koyama E., Naruse K., Shigetomi H., et al. Combination of B-Lynch brace suture and uterine artery embolization for atonic bleeding after cesarean section in a patient with placenta previa accreta // J. Obstet. Gynaecol. Res. 2012. Vol. 38, N 1. P. 345–348. doi: 10.1111/j.1447-0756.2011.01699.x |
| [45] |
Koyama E, Naruse K, Shigetomi H, et al. Combination of B-Lynch brace suture and uterine artery embolization for atonic bleeding after cesarean section in a patient with placenta previa accreta. J. Obstet. Gynaecol. Res. 2012;38(1):345–348. doi: 10.1111/j.1447-0756.2011.01699.x |
| [46] |
Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2017;217(1):27–36. doi: 10.1016/j.ajog.2017.02.050 |
| [47] |
Jauniaux E., Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis // Am. J. Obstet. Gynecol. 2017. Vol. 217, N 1. P. 27–36. doi: 10.1016/j.ajog.2017.02.050 |
| [48] |
Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2017;217(1):27–36. doi: 10.1016/j.ajog.2017.02.050 |
| [49] |
Horgan R, Abuhamad A. Placenta accreta spectrum: prenatal diagnosis and management. Obstet Gynecol Clin North Am. 2022;49(3):423–438. doi: 10.1016/j.ogc.2022.02.004 |
| [50] |
Horgan R., Abuhamad A. Placenta accreta spectrum: prenatal diagnosis and management // Obstet Gynecol Clin North Am. 2022. Vol. 49, N 3. P. 423–438. doi: 10.1016/j.ogc.2022.02.004 |
| [51] |
Horgan R, Abuhamad A. Placenta accreta spectrum: prenatal diagnosis and management. Obstet Gynecol Clin North Am. 2022;49(3):423–438. doi: 10.1016/j.ogc.2022.02.004 |
| [52] |
Kilcoyne A, Shenoy-Bhangle AS, Roberts DJ, et al. MRI of placenta accreta, placenta increta, and placenta percreta: pearls and pitfalls. Am. J. Roentgenol. 2017;208(1):214–221. doi: 10.2214/AJR.16.16281 |
| [53] |
Kilcoyne A., Shenoy-Bhangle A.S., Roberts D.J., et al. MRI of placenta accreta, placenta increta, and placenta percreta: pearls and pitfalls // Am. J. Roentgenol. 2017. Vol. 208, N 1. P. 214–221. doi: 10.2214/AJR.16.16281 |
| [54] |
Kilcoyne A, Shenoy-Bhangle AS, Roberts DJ, et al. MRI of placenta accreta, placenta increta, and placenta percreta: pearls and pitfalls. Am. J. Roentgenol. 2017;208(1):214–221. doi: 10.2214/AJR.16.16281 |
| [55] |
Einerson BD, Rodriguez CE, Kennedy AM, et al. Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders. Am. J. Obstet. Gynecol. 2018;218(6):618.e1–618.e7. doi: 10.1016/j.ajog.2018.03.013 |
| [56] |
Einerson B.D., Rodriguez C.E., Kennedy A.M., et al. Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders // Am. J. Obstet. Gynecol. 2018. Vol. 218, N 6. P. 618e1–618e7. doi: 10.1016/j.ajog.2018.03.013 |
| [57] |
Einerson BD, Rodriguez CE, Kennedy AM, et al. Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders. Am. J. Obstet. Gynecol. 2018;218(6):618.e1–618.e7. doi: 10.1016/j.ajog.2018.03.013 |
| [58] |
Dvoretskiy LI, Zaspa EA, Vokalyuk RM. Strategy and tactics of management of patients with iron deficiency anemia. RMJ. 2008;16(7):445–451. (In Russ.) EDN: THXCNF |
| [59] |
Дворецкий Л.И., Заспа Е.А., Вокалюк Р.М. Стратегия и тактика ведения больных железодефицитной анемией // РМЖ. 2008. Т. 16, № 7. С. 445–451. EDN: THXCNF |
| [60] |
Dvoretskiy LI, Zaspa EA, Vokalyuk RM. Strategy and tactics of management of patients with iron deficiency anemia. RMJ. 2008;16(7):445–451. (In Russ.) EDN: THXCNF |
| [61] |
Matsuzaki S, Ueda Y, Matsuzaki S, et al. Relationship between abnormal placenta and obstetric outcomes: a meta-analysis. Biomedicines. 2023;11(6):1522. doi: 10.3390/biomedicines11061522 |
| [62] |
Matsuzaki S., Ueda Y., Matsuzaki S., et al. Relationship between abnormal placenta and obstetric outcomes: a meta-analysis // Biomedicines. 2023. Vol. 11, N 6. P. 1522. doi: 10.3390/biomedicines11061522 |
| [63] |
Matsuzaki S, Ueda Y, Matsuzaki S, et al. Relationship between abnormal placenta and obstetric outcomes: a meta-analysis. Biomedicines. 2023;11(6):1522. doi: 10.3390/biomedicines11061522 |
| [64] |
Sentilhes L, Seco A, Azria E, et al. Conservative management or cesarean hysterectomy for placenta accreta spectrum: the PACCRETA prospective study. Am J Obstet Gynecol. 2022;226(6):839.e1–839.e24. doi: 10.1016/j.ajog.2021.12.013 |
| [65] |
Sentilhes L., Seco A., Azria E., et al. Conservative management or cesarean hysterectomy for placenta accreta spectrum: the PACCRETA prospective study // Am J Obstet Gynecol. 2022. Vol. 226, N 6. P. 839.e1–839.e24. doi: 10.1016/j.ajog.2021.12.013 |
| [66] |
Sentilhes L, Seco A, Azria E, et al. Conservative management or cesarean hysterectomy for placenta accreta spectrum: the PACCRETA prospective study. Am J Obstet Gynecol. 2022;226(6):839.e1–839.e24. doi: 10.1016/j.ajog.2021.12.013 |
Eco-Vector
/
| 〈 |
|
〉 |